Dietzen, Charles Joseph

Dietzen, Charles Joseph is an individual health care provider with primary practice located at 705 Riley Hospital Dr Ri 3146, Indianapolis IN 46202-5109. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Rehabilitation Medicine, which is considered as his primary health care specialty. Dietzen, Charles Joseph can be contacted via phone (317) 944-2353.

Contact Information

Primary practice address
705 Riley Hospital Dr Ri 3146 Indianapolis IN 46202-5109
Phone: (317) 944-2353
Fax: (317) 944-2390
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Rehabilitation Medicine 2081P0010X 01036773A Indiana

Profile Details

NPI number 1790756385
LBN Legal business name Dietzen, Charles Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 31st, 2006
Last updated Dec 18th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790756385 NPPES
Indiana MEDICAID 100284930

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